Provider Demographics
NPI:1548341191
Name:RIGGS, DANIEL E (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:RIGGS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 BUNKER DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6200
Mailing Address - Country:US
Mailing Address - Phone:217-228-8458
Mailing Address - Fax:
Practice Address - Street 1:3915 MAINE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5843
Practice Address - Country:US
Practice Address - Phone:217-222-9434
Practice Address - Fax:217-222-0671
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0018261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019023491Medicaid
IL019023491Medicaid
ILK02248Medicare UPIN